People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training is aimed at improving control of the body’s stabilising muscles. Despite a lack of evidence regarding its effectiveness, this exercise approach is now popular with both people with MS and therapists. Evidence regarding efficacy is vital in order that people with MS can use limited time, energy and therapy resources to best effect.

A replicated single case series study facilitated by the Therapists in MS Group, recently provided preliminary evidence that core stability training improves balance and mobility in ambulant people with MS [Freeman et al 2010]. We have now received funding to build upon this work by undertaking a multi-centred randomised controlled study, with the aims of :
1. Establishing the effectiveness of core stability training in people with MS
2. Comparing core stability training with standardised physiotherapy exercise
3. Exploring underlying mechanisms of change associated with this intervention

This multi-centre randomised controlled study will involve the following five centres, each of whom will recruit 20 patients into the trial: James Cook University Hospital, South Tees NHS Trust, Cleveland; Kenilworth Medical Centre, NHS Lanarkshire, Cumbernauld; National Hospital for Neurology and Neurosurgery, University College Hospitals London; Newton Abbot Hospital, NHS Devon; and the School of Health Professions, University of Plymouth.

Whole Body Vibration (WBV) therapy is emerging within the field of neurological physiotherapy. WBV therapy involves an individual sitting or standing on a platform whilst vibrations are passed through the body, the vibrations are then passed though the feet or the buttocks. Vibrosphere® is a tool based on the physiological basis of WBV with the addition of providing the opportunity for a portable, moving platform, as it comes in the form of a circular wobble board. Vibrosphere® can be utilised to operate either statically, or as a mobile platform, but has the advantage of being portable. There is emerging evidence that WBV therapy improves the feed-forward mechanism of postural control in normal subjects.

This project aims to investigate (via a series of single case studies)the effects of WBV therapy on a series of individuals with postural control deficits and assess feasibility of the use of the Vibrosphere® platform in doing this.

1. “Spinal motion in people with chronic low back pain: a pilot study”. This study is piloting a new model for use with the Vicon MX 3-Dimensional motion analysis system in order to measure kinematics of the lumbar spine during several movements, including functional activities such as walking and sit-stand-sit. It is anticipated that this study will lead to further investigation of spinal kinematics in people with chronic low back pain which may be linked to sub classification and response to treatments.
Co-applicants: Mrs Lyndsay Alexander, Dr Ioannis Agouris, Dr Mandy Plumb
Funding: Institute for Health & Welfare Research, Robert Gordon University, Pump-priming funding

2. “An exploration of initial physiotherapy assessments in musculoskeletal outpatients”. This qualitative study is investigating patients’ and physiotherapists’ perceptions of initial outpatient physiotherapy assessments. Patients and physiotherapists who have experienced longer or shorter duration initial assessments will take part in interviews and focus groups in order to explore the issues surrounding the duration of initial physiotherapy assessments. It is anticipated that this research will influence future service design and provision, as well as providing initial findings to inform future research in the area
Co-applicants: Mrs Susan Massie, Mrs Lynn Morrison
Funding: NHS Grampian Endowment Research Fund; Alliance for Self-Care Research

3. “Self-management of chronic low back pain”. This qualitative study is investigating self-management of chronic low back pain from physiotherapists’ and their patients’ perspectives. Physiotherapists and their patients are participating in semi-structured interviews to explore the issues surrounding self-management of chronic low back pain following discharge from physiotherapy. It is anticipated that this research may influence the information and advice provided to patients, as well as informing future research on the topic
Co-applicant: Mrs Lyndsay Alexander
Funding: Alliance for Self Care Research